Abstract
BackgroundCoronary Heart Disease (CHD) remains a major cause of mortality in the United Kingdom. Yet predictions of future CHD mortality are potentially problematic due to population ageing and increase in obesity and diabetes. Here we explore future projections of CHD mortality in England & Wales under two contrasting future trend assumptions.MethodsIn scenario A, we used the conventional counterfactual scenario that the last-observed CHD mortality rates from 2011 would persist unchanged to 2030. The future number of deaths was calculated by applying those rates to the 2012–2030 population estimates. In scenario B, we assumed that the recent falling trend in CHD mortality rates would continue. Using Lee-Carter and Bayesian Age Period Cohort (BAPC) models, we projected the linear trends up to 2030. We validate our methods using past data to predict mortality from 2002–2011. Then, we computed the error between observed and projected values.ResultsIn scenario A, assuming that 2011 mortality rates stayed constant by 2030, the number of CHD deaths would increase 62% or approximately 39,600 additional deaths. In scenario B, assuming recent declines continued, the BAPC model (the model with lowest error) suggests the number of deaths will decrease by 56%, representing approximately 36,200 fewer deaths by 2030.ConclusionsThe decline in CHD mortality has been reasonably continuous since 1979, and there is little reason to believe it will soon halt. The commonly used assumption that mortality will remain constant from 2011 therefore appears slightly dubious. By contrast, using the BAPC model and assuming continuing mortality falls offers a more plausible prediction of future trends. Thus, despite population ageing, the number of CHD deaths might halve again between 2011 and 2030. This has implications for how the potential benefits of future cardiovascular strategies might best be calculated and presented.
Highlights
The halving of UK Coronary Heart Disease (CHD) death rates since the 1970s represents a major public health achievement
The English NHS Health Checks programme is based on the assumption that the risk of dying from cardiovascular disease (CVD) will persist unchanged in the future [19]
We show this in terms of forecast CHD mortality rates and number of CHD deaths
Summary
The halving of UK Coronary Heart Disease (CHD) death rates (mortality) since the 1970s represents a major public health achievement. Strategies to maximise the prevention of CHD and cardiovascular disease (CVD) remain a top policy priority. In the United States, the annual rate of decline for men aged 35 to 54 fell from 6.2% per annum in the 1980s to 0.5% in the 2000s [3]. In England and Wales, CHD mortality declines were not just slowing [4] but in 2002 for the first time in over two decades, CHD mortality increased among men aged 35–44 years. Coronary Heart Disease (CHD) remains a major cause of mortality in the United Kingdom. We explore future projections of CHD mortality in England & Wales under two contrasting future trend assumptions
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